Healthcare Provider Details

I. General information

NPI: 1326418625
Provider Name (Legal Business Name): THERESA MCLAUGHLIN OTR-L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11506 NICHOLAS ST
OMAHA NE
68154-4407
US

IV. Provider business mailing address

3309 WALTON WAY
ROSWELL GA
30076-3493
US

V. Phone/Fax

Practice location:
  • Phone: 877-230-3885
  • Fax:
Mailing address:
  • Phone: 863-258-6362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number117201
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: